Health insurance premiums on the Affordable Care Act’s marketplaces (also called exchanges) are expected to increase faster in 2017 than in previous years due to a combination of factors, including substantial losses experienced by many insurers in this market and the phasing out of the ACA’s reinsurance program. We analyzed 2017 premiums and insurer participation made available through Healthcare.gov on October 24, 2017, as well as data collected from states that run their own exchange websites.

Changes in the Second-Lowest Silver Premium

The second-lowest silver plan is one of the most popular plan choices on the marketplace and is also the benchmark that is used to determine the amount of financial assistance individuals and families receive. The table below shows these premiums for a major city in each state with available data. (We have been reporting premiums in these cities since the launch of the ACA’s exchanges in 2014; similar analyses for 2015 and 2016 are also available.)

Across these major cities in 2016, the second-lowest silver premium for a 40-year-old non-smoker ranged from $186 per month in Albuquerque, NM to $719 in Anchorage, AK, before accounting for the tax credit that most enrollees in this market receive. In 2017, the second-lowest silver premium for a 40-year-old non-smoker living in these cities will range from $229 in Louisville, KY and Cleveland, OH to $904 in Anchorage, AK, before accounting for the tax credit.

Of these major cities, the places with the largest increases in the unsubsidized second-lowest silver plan were Phoenix, AZ (up 145% from $207 to $507 per month for a 40-year-old non-smoker), Birmingham, AL (up 71% from $288 to $492) and Oklahoma City, OK (up 67% from $295 to $493). Meanwhile, unsubsidized premiums for the second-lowest silver premiums will decrease in Indianapolis, IN (down -4% from $298 to $286 for a 40-year-old non-smoker), Cleveland, OH (down -2% from $234 to $229), Boston, MA (down -1% from $250 to $247), and Providence, RI (down -1% from $263 to $261) and increase just 1% in Little Rock, AR (from $310 to $314).

Most enrollees in the marketplaces receive a tax credit to lower their premium. In most parts of the country in 2016, a 40-year-old adult making $30,000 per year would pay about $208 per month for the second-lowest-silver plan. If this person is willing to switch to whatever the new second lowest-cost silver plan is in 2017, they will pay a similar amount (the after-tax credit payment for a similar person in 2017 is $207 per month or a change of 0%). In some parts of the country (for example, in Albuquerque, NM), premiums for a 40-year-old are so low in 2016 that an enrollee making $30,000 may not have qualified for a subsidy. In these places, an increase in the benchmark silver premium may make them newly-eligible for financial assistance.

Table 1: Monthly Silver Premiums and Financial Assistance
for a 40 Year Old Non-Smoker Making $30,000 / Year

State

Major City

2nd Lowest Cost Silver
Before Tax Credit

2nd Lowest Cost Silver
After Tax Credit

Amount of
Premium Tax Credit

2016

2017

% Change
from 2016

2016

2017

% Change
from 2016

2016

2017

% Change
from 2016

Alabama

Birmingham

$288

$492

71%

$208

$207

0%

$80

$285

256%

Alaska

Anchorage

$719

$904

26%

$164

$163

-1%

$555

$741

33%

Arizona

Phoenix

$207

$507

145%

$207

$207

0%

$0

$300

N/A

Arkansas

Little Rock

$310

$314

1%

$208

$207

0%

$102

$107

4%

California

Los Angeles

$245

$258

5%

$208

$207

0%

$37

$51

38%

Colorado

Denver

$278

$313

12%

$208

$207

0%

$70

$106

51%

Connecticut

Hartford

$318

$404

27%

$208

$207

0%

$110

$196

79%

Delaware

Wilmington

$356

$423

19%

$208

$207

0%

$148

$216

46%

DC

Washington

$244

$298

22%

$208

$207

0%

$36

$91

153%

Florida

Miami

$262

$306

17%

$208

$207

0%

$54

$99

84%

Georgia

Atlanta

$254

$286

13%

$208

$207

0%

$46

$79

72%

Hawaii

Honolulu

$262

$347

32%

$179

$178

-1%

$83

$169

104%

Idaho

Boise

$273

$348

27%

$208

$207

0%

$65

$141

117%

Illinois

Chicago

$198

$291

48%

$198

$207

5%

$0

$84

N/A

Indiana

Indianapolis

$298

$286

-4%

$208

$207

0%

$90

$79

-12%

Iowa

Cedar Rapids

$284

$301

6%

$208

$207

0%

$76

$94

25%

Kansas

Wichita

$248

$361

46%

$208

$207

0%

$40

$154

287%

Kentucky

Louisville

$223

$229

3%

$208

$207

0%

$15

$22

47%

Louisiana

New Orleans

$332

$373

13%

$208

$207

0%

$124

$166

34%

Maine

Portland

$288

$341

19%

$208

$207

0%

$80

$134

68%

Maryland

Baltimore

$249

$309

24%

$208

$207

0%

$41

$102

152%

Massachusetts

Boston

$250

$247

-1%

$208

$207

0%

$42

$40

-5%

Michigan

Detroit

$226

$237

5%

$208

$207

0%

$18

$29

65%

Minnesota

Minneapolis

$235

$366

55%

$208

$207

0%

$27

$159

481%

Mississippi

Jackson

$283

$352

25%

$208

$207

0%

$75

$145

95%

Missouri

St Louis

$287

$310

8%

$208

$207

0%

$79

$103

31%

Montana

Billings

$322

$425

32%

$208

$207

0%

$114

$218

92%

Nebraska

Omaha

$313

$368

18%

$208

$207

0%

$105

$161

54%

Nevada

Las Vegas

$261

$282

8%

$208

$207

0%

$53

$75

41%

New Hampshire

Manchester

$261

$267

2%

$208

$207

0%

$53

$60

14%

New Jersey

Newark

$330

$353

7%

$208

$207

0%

$122

$146

19%

New Mexico

Albuquerque

$186

$258

39%

$186

$207

11%

$0

$51

N/A

New York

New York City

$369

$456

24%

$208

$207

0%

$161

$249

55%

North Carolina

Charlotte

$409

$572

40%

$208

$207

0%

$201

$364

82%

North Dakota

Fargo

$304

$331

9%

$208

$207

0%

$96

$124

29%

Ohio

Cleveland

$234

$229

-2%

$208

$207

0%

$26

$22

-17%

Oklahoma

Okla. City

$295

$493

67%

$208

$207

0%

$87

$286

230%

Oregon

Portland

$261

$312

20%

$208

$207

0%

$53

$105

98%

Pennsylvania

Philadelphia

$276

$418

51%

$208

$207

0%

$68

$211

209%

Rhode Island

Providence

$263

$261

-1%

$208

$207

0%

$55

$54

-2%

South Carolina

Columbia

$314

$404

29%

$208

$207

0%

$106

$197

85%

South Dakota

Sioux Falls

$309

$448

45%

$208

$207

0%

$101

$241

138%

Tennessee

Nashville

$281

$419

49%

$208

$207

0%

$73

$212

192%

Texas

Houston

$256

$288

13%

$208

$207

0%

$48

$81

69%

Utah

Salt Lake City

$244

$292

20%

$208

$207

0%

$36

$85

139%

Vermont

Burlington

$468

$492

5%

$208

$207

0%

$260

$285

9%

Virginia

Richmond

$276

$296

7%

$208

$207

0%

$68

$89

31%

Washington

Seattle

$227

$238

5%

$208

$207

0%

$19

$31

62%

West Virginia

Huntington

$341

$419

23%

$208

$207

0%

$132

$212

60%

Wisconsin

Milwaukee

$326

$379

16%

$208

$207

0%

$117

$172

46%

Wyoming

Cheyenne

$426

$464

9%

$208

$207

0%

$218

$257

18%

NOTES: In areas in which the two lowest-cost silver plans have the same premium, the next lowest-cost silver plan is used as the “second-lowest” silver plan. In some cases, a portion of the second lowest-cost silver plan is for non-essential health benefits so these values may differ from the benchmark used to determine subsidies.
SOURCE: Kaiser Family Foundation analysis of premium data from Healthcare.gov and insurer rate filings to state regulators. For more information see “Early Look at 2017 Premium Changes and Insurer Participation in the Affordable Care Act’s Health Insurance Marketplaces” Jul 2016.

Changes in Insurer Participation

As a result of losses in this market, some insurers like UnitedHealth and Aetna have announced their withdrawal from the ACA marketplaces or the individual market in some states. In 2016, the number of insurers participating in each state (grouped by parent company) ranged from 1 in Wyoming to 16 in Texas. In states that use Healthcare.gov, the average number of insurers participating in the marketplace will be 3.9 in 2017 (down from 5.4 companies per state in 2016, 5.9 in 2015 and 4.5 in 2014). Marketplace insurer participation in states using Healthcare.gov in 2017 ranges from 1 company in Alabama, Alaska, Oklahoma, South Carolina, and Wyoming, to 15 companies in Wisconsin.

Table 2: Total Number of Insurers by State, 2014 – 2017

Total Number of Issuers in the Marketplace

State

2014

2015

2016

2017

Alabama

2

3

3

1

Alaska

2

2

2

1

Arizona

8

11

8

2

Arkansas

3

4

4

3

California

11

10

12

NA

Colorado

10

10

8

NA

Connecticut

3

4

4

NA

Delaware

2

2

2

2

DC

3

3

2

NA

Florida

8

10

7

5

Georgia

5

9

8

5

Hawaii

2

2

2

2

Idaho

4

5

5

NA

Illinois

5

8

7

5

Indiana

4

8

7

4

Iowa

4

4

4

4

Kansas

3

3

3

3

Kentucky

3

5

7

3

Louisiana

4

5

4

3

Maine

2

3

3

3

Maryland

4

5

5

NA

Massachusetts

10

10

10

NA

Michigan

9

13

11

9

Minnesota

5

4

5

NA

Mississippi

2

3

3

2

Missouri

3

6

6

4

Montana

3

4

3

3

Nebraska

4

4

4

2

Nevada

4

5

3

3

New Hampshire

1

5

5

4

New Jersey

3

5

5

2

New Mexico

4

5

4

4

New York

16

16

15

NA

North Carolina

2

3

3

2

North Dakota

3

3

3

3

Ohio

11

15

15

11

Oklahoma

4

4

2

1

Oregon

11

10

10

6

Pennsylvania

7

9

7

6

Rhode Island

2

3

3

NA

South Carolina

3

4

3

1

South Dakota

3

3

2

2

Tennessee

4

5

4

3

Texas

11

14

16

10

Utah

6

6

4

3

Vermont

2

2

2

NA

Virginia

5

6

7

9

Washington

7

9

9

NA

West Virginia

1

1

2

2

Wisconsin

13

15

16

15

Wyoming

2

2

1

1

HealthCare.gov Average

4.5

5.9

5.4

3.9

US Average

5

6.1

5.7

NA

SOURCE: Kaiser Family Foundation analysis of premium data from Healthcare.gov and insurer rate filings to state regulators. For more information see “Early Look at 2017 Premium Changes and Insurer Participation in the Affordable Care Act’s Health Insurance Marketplaces” Jul 2016.
NOTES: Insurers are grouped by parent company or group affiliation, which we obtained from HHS Medical Loss Ratio public use files and supplemented with additional research. For 2017, the number of insurers in non-Healthcare.gov states is not yet available.